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الاثنين، 28 فبراير، 2011

Mental Disorders in America

Mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year.1 When applied to the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translates to 57.7 million people.2 Even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 — who suffer from a serious mental illness.1 In addition, mental disorders are the leading cause of disability in the U.S. and Canada.3 Many people suffer from more than one mental disorder at a given time. Nearly half (45 percent) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity.1

In the U.S., mental disorders are diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).4

Symptoms of dysthymic disorder (chronic, mild depression) must persist for at least two years in adults (one year in children) to meet criteria for the diagnosis. Dysthymic disorder affects approximately 1.5 percent of the U.S. population age 18 and older in a given year.1, This figure translates to about 3.3 million American adults.2

Approximately 6 million American adults ages 18 and older, or about 2.7 percent of people in this age group in a given year, have panic disorder.1,2

Panic disorder typically develops in early adulthood (median age of onset is 24), but the age of onset extends throughout adulthood.5

About one in three people with panic disorder develops agoraphobia, a condition in which the individual becomes afraid of being in any place or situation where escape might be difficult or help unavailable in the event of a panic attack.12

Approximately 7.7 million American adults age 18 and older, or about 3.5 percent of people in this age group in a given year, have PTSD.1,2

PTSD can develop at any age, including childhood, but research shows that the median age of onset is 23 years.5

About 19 percent of Vietnam veterans experienced PTSD at some point after the war.13 The disorder also frequently occurs after violent personal assaults such as rape, mugging, or domestic violence; terrorism; natural or human-caused disasters; and accidents.

Approximately 15 million American adults age 18 and over, or about 6.8 percent of people in this age group in a given year, have social phobia.1

Social phobia begins in childhood or adolescence, typically around 13 years of age.5

Agoraphobia

Agoraphobia involves intense fear and anxiety of any place or situation where escape might be difficult, leading to avoidance of situations such as being alone outside of the home; traveling in a car, bus, or airplane; or being in a crowded area.5

Approximately 1.8 million American adults age 18 and over, or about 0.8 percent of people in this age group in a given year, have agoraphobia without a history of panic disorder.1,2

The three main types of eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder.

In their lifetime, an estimated 0.6 percent of the adult population in the U.S. will suffer from anorexia, 1.0 percent from bulimia, and 2.8 percent from a binge eating disorder. 14

Women are much more likely than males to develop an eating disorder. They are three times as likely to experience anorexia (0.9 percent of women vs. 0.3 percent of men) and bulimia (1.5 percent of women vs. 0.5 percent of men) during their life. They are also 75 percent more likely to have a binge eating disorder (3.5 percent of women vs. 2.0 percent of men).14

The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population.15

ADHD, one of the most common mental disorders in children and adolescents, also affects an estimated 4.1 percent of adults, ages 18-44, in a given year.1

ADHD usually becomes evident in preschool or early elementary years. The median age of onset of ADHD is seven years, although the disorder can persist into adolescence and occasionally into adulthood.5

Autism is part of a group of disorders called autism spectrum disorders (ASDs), also known as pervasive developmental disorders. ASDs range in severity, with autism being the most debilitating form while other disorders, such as Asperger syndrome, produce milder symptoms.

Estimating the prevalence of autism is difficult and controversial due to differences in the ways that cases are identified and defined, differences in study methods, and changes in diagnostic criteria. A recent study by the Centers for Disease Control and Prevention (CDC) reported the prevalence of autism among 8 year-olds to be about 1 in 110.16

Autism and other ASDs develop in childhood and generally are diagnosed by age three.17

Autism is about four times more common in boys than girls. Girls with the disorder, however, tend to have more severe symptoms and greater cognitive impairment.16,17

Personality Disorders

Personality disorders represent "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it."4 These patterns tend to be fixed and consistent across situations and are typically perceived to be appropriate by the individual even though they may markedly affect their day-to-day life in negative ways. Among American adults ages 18 and over, an estimated 9.1% have a diagnosable personality disorder.18 Several more common personality disorders include:

Antisocial Personality Disorder

Antisocial personality disorder is characterized by an individual's disregard for social rules and cultural norms, impulsive behavior, and indifference to the rights and feelings of others.

Approximately 1.0 percent of people aged 18 or over have antisocial personality disorder.18

Avoidant Personality Disorder

Avoidant personality disorder is characterized by extreme social inhibition, sensitivity to negative evaluation, and feelings of inadequacy. Individuals with avoidant personality disorder frequently avoid social interaction for fear of being ridiculed, humiliated, or disliked.

An estimated 5.2 percent of people age 18 or older have an avoidant personality disorder.18

Borderline Personality Disorder (BPD) is defined by the DSM-IV as "a pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts.”

الأحد، 27 فبراير، 2011

But the response is muted rather than negative, study finds

SATURDAY, Feb. 26 (HealthDay News) -- Armed with brain scans, researchers have discovered bawling babies trigger a far more muted response in the brains of depressed mothers than in mothers who aren't depressed.

Contrary to a previous theory, "it looks as though depressed mothers are not responding in a more negative way than non-depressed mothers. What we saw was really more of a lack of responding in a positive way," said study lead author Heidemarie K. Laurent in a news release from the University of Oregon.

Laurent is an assistant professor at the University of Wyoming, but she worked on the study as a postdoctoral researcher at the University of Oregon.

The study, which appears online in the journal Social Cognitive and Affective Neuroscience, is the first to examine how the brains of depressed women responded to the crying of babies.

In total, the researchers studied the brains of 22 women using functional magnetic resonance imaging, which measures brain activity through blood flow changes. The women were all first-time mothers with 18-month-old babies

CHICAGO - YouTube videos on cutting and other self-injury methods are an alarming new trend, attract millions of hits and could serve as a how-to for troubled viewers, a study warns.

Many videos show bloody live enactments or graphic photos of people cutting their arms or legs with razors or other sharp objects, the study found. Many also glamorize self-injury and few videos discourage it, the study authors said.

They also feature haunting music and rich imagery that may attract young self-injurers and trigger the behavior, especially in those who have just started to self-injure, the authors suggest.

Canadian psychologist Stephen Lewis, a study co-author, said he found more than 5,000 YouTube videos on self-injury. The study focused on 100 videos the authors found in December 2009. Their analysis was published online Monday in Pediatrics.

The 100 videos were viewed more than 2 million times and generated many online comments.

Parents and mental health professionals should be aware of the YouTube postings and that the videos might be perpetuating the problem, said Lewis, an assistant professor at the University of Guelph in Ontario.

The study's authors also recommended that YouTube provide helpful resources or links when people enter search terms for "self-injury." A company spokeswoman said YouTube is looking into the feasibility of the suggestion

The studies, published in the journal Neurology, measure the ability of children with attention deficit hyperactivity disorder (ADHD) to control impulsive movements (motor control).

This new measurement of symptoms may help experts improve their understanding of the neurobiology of ADHD, inform prognosis and guide treatments.

In one of two studies, children with ADHD performed a finger-tapping task. Any unintentional “overflow” movements occurring on the opposite hand were noted.

Children with ADHD showed more than twice the amount of overflow than typically developing children. This is the first time that scientists have been able to quantify the degree to which ADHD is associated with a failure in motor control.

The single most common child behavioral diagnosis, ADHD is a highly prevalent developmental disorder characterized by inattentiveness, hyperactivity and impulsivity

By Rick Nauert PhDSenior News EditorReviewed by John M. Grohol, Psy.D. on February 17, 2011

Despite a remarkable lifespan of over 70 years, lithium continues to be an effective treatment for the manic and depressive episodes of bipolar disorder.

Researchers are only now beginning to understand how lithium works. Ongoing research now suggests that lithium can help restore brain volume deficits.

Only in the past 15 years have the molecular mechanisms underlying the treatment of bipolar disorder become known.

During this time frame studies conducted on animals began to identify neuroprotective and perhaps neurotrophic effects of this important medication.

The identification of these molecular actions of lithium coincided with the discovery of regional brain volume deficits in imaging studies of people with bipolar disorder.

In particular, a generation of research studies identified alterations, predominately reductions, in the size of brain regions involved in mood regulation. These studies also began to provide hints that some of the treatments for bipolar disorder would increase the volumes of these brain regions.

In a massive research effort published in Biological Psychiatry, eleven international research groups collaborated to pool brain imaging data from adults with bipolar disorder. This allowed them to perform a mega-analysis to evaluate the differences in brain structure between individuals with bipolar disorder and healthy comparison subjects.

They found that individuals with bipolar disorder had increased right lateral ventricular, left temporal lobe, and right putamen volumes.

Individuals with bipolar disorder who were not taking lithium had a reduction in cerebral and hippocampal volumes compared with healthy comparison subjects.

Cerebral volume reduction was also significantly associated with illness duration in bipolar individuals.

“This important mega-analysis provides strong support for regional brain structural alterations associated with bipolar disorder, but also sends a signal of hope that treatments for this disorder may reduce some of these deficits,” commented Dr. John Krystal, Editor of Biological Psychiatry.

الخميس، 17 فبراير، 2011

Recently, there’s been an interesting discussion on the Academy of Cognitive Therapy listserv about the therapy notes patients take home with them to review. Here’s how I make sure a patient is able to remember important ideas we discussed in treatment, specifically the changes a patient makes in his thinking:

Generally, when I ascertain that the patient has modified his thinking during a session (e.g., following Socratic questioning, behavioral experiments, roleplaying, etc.), I’ll ask the patient for a summary. I might say:

• Can you summarize what we just talked about?
• What do you think it would be important for you to remember this week?
• What do you think the main message is?

If the patient comes up with a good summary, I positively reinforce him and ask whether he wants to write it down or if he would like me to do so. If his summary is not quite on point, I usually offer a revised version and ask the patient whether he thinks it might be helpful to remember it this latter way. If he agrees, he or I will write the summary down. At that point or later on in the session, I will ask the patient how likely it is that he will read these important therapy notes every day at home. If he’s not highly likely, I’ll ask him about what might get in the way.

I’ve found that most patients just don’t learn the skill of writing cogent summaries. They rarely write down complete ideas and they usually add in extraneous or less important material which dilutes what is really important; that’s why I’m nicely directive about what is written down. I want to be certain the patient has good notes to read this week and ten years from now, if a similar problem arises.

الأربعاء، 16 فبراير، 2011

Oxytocin may accentuate social tendencies for good or ill

By Bruce Bower, Science News

SAN ANTONIO—Oxytocin, a hormone with a rosy reputation for getting people to love, trust and generally make nice with one another, can get down and dirty, according to evidence presented on January 28 at the annual meeting of the Society for Personality and Social Psychology.

This brain-altering substance apparently amplifies whatever social proclivities a person already possesses, whether positive or negative, says psychologist Jennifer Bartz of Mount Sinai School of Medicine in New York City.

Previous work has shown that a nasal blast of the hormone encourages a usually trusting person to become more trusting (SN Online: 5/21/08), but now Bartz and her colleagues find that it also makes a highly suspicious person more uncooperative and hostile than ever.

“Oxytocin does not simply make everyone feel more secure, trusting and prosocial,” Bartz says.

These new results raise concerns about plans by some researchers to administer oxytocin to people with autism and other psychiatric conditions that include social difficulties, she adds

The study concerns the specific cognitive and adaptive skills of persons dually diagnosed with mental retardation (MR) and comorbid pathologies, as schizophrenia, personality and mood disorders, pervasive developmental disorders, epilepsy and ADHD. The sample was composed of 182 subjects, diagnosed as mild or moderate MR level, age range from 6 years 8 months to 50 years 2 months, mean age 17.1 (standard deviation 7.9). All the subjects were inpatients in a specialized structure for the diagnosis and the

treatment of MR. The instruments of the study were Wechsler Intelligence Scale (WAIS-R or WISC-R according to the chronological age of subjects) and Vineland Adaptive Behavior Scale (VABS). Results confirm that comorbidity is a factor differentiating among mentally retarded subjects. Both verbal processes requiring memory retrieval and visuo-spatial processes are involved as differentiating features. ADHD strongly increases the impairment of cognitive skills, while behavioral disorders are less damaging in MR performance. In adult samples, the differentiating role of comorbid syndromes in MR individuals is reduced for cognitive skills, and limited to some basic verbal abilities, more impaired in mood disorder, less in schizophrenic disorder.The areas of adaptation and socialization, motor and daily living skills, are impaired more in generalized development disturbances than in comorbid schizophrenic and personality and mood disorders. An accurate psychological assessment of dual diagnoses is useful in detecting the specific underlying processes differentiating the comorbid syndromes, and in planning an appropriate rehabilitative treatment.

In the brain imaging study, researchers from UC Berkeley and Cambridge University discovered two distinct neural pathways that play a role in whether we develop and overcome fears. The first involves an overactive amygdala, which is home to the brain’s primal fight-or-flight reflex and plays a role in developing specific phobias.

The second involves activity in the ventral prefrontal cortex, a neural region that helps us to overcome our fears and worries. Some participants were able to mobilize their ventral prefrontal cortex to reduce their fear responses even while negative events were still occurring, the study found.

“This finding is important because it suggests some people may be able to use this ventral frontal part of the brain to regulate their fear responses – even in situations where stressful or dangerous events are ongoing,” said UC Berkeley psychologist Dr. Sonia Bishop, lead author of the paper.

“If we can train those individuals who are not naturally good at this to be able to do this, we may be able to help chronically anxious individuals as well as those who live in situations where they are exposed to dangerous or stressful situations over a long time frame,” Bishop added.

Bishop and her team used functional Magnetic Resonance Imaging (fMRI) to examine the brains of 23 healthy adults. As their brains were scanned, participants viewed various scenarios in which a virtual figure was seen in a computerized room.

In one room, the figure would place his hands over his ears before a loud scream was sounded. But in another room, the gesture did not predict when the scream would occur. This placed volunteers in a sustained state of anticipation.

Participants who showed overactivity in the amygdala developed much stronger fear responses to gestures that predicted screams. A second entirely separate risk factor turned out to be failure to activate the ventral prefrontal cortex.

Researchers found that participants who were able to activate this region were much more capable of decreasing their fear responses, even before the screams stopped.

The discovery that there is not one, but two routes in the brain circuitry that lead to heightened fear or anxiety is a key finding, the researchers said, and it offers hope for new targeted treatment approaches.

“Some individuals with anxiety disorders are helped more by cognitive therapies, while others are helped more by drug treatments,” Bishop said.

“If we know which of these neural vulnerabilities a patient has, we may be able to predict what treatment is most likely to be of help.”